Bi-directional Suture Passer for Annular Defect Repair
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Solution Overview
Problem
Conventional lumbar discectomy procedures fail to adequately repair annular defects, leading to potential post-operative complications such as reherniation or disc height collapse.
Innovation Solution
A bidirectional suture passing instrument is designed to approximate and repair soft tissue defects by using a housing with cannulations and a shuttling element to carry a strand of suture, allowing for tissue penetration and approximation across a tissue receiving gap, effectively closing or repairing annular defects.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If extensive debulking is performed to minimize reherniation risk, then the risk of post-operative reherniation decreases, but the risk of disc height collapse and lower back pain increases
Solution Approach 1:
The suture is passed through the annular defect before completing the debulking procedure, allowing the defect to be repaired and reinforced in advance. This preliminary reinforcement prevents disc height collapse and provides structural support that reduces the need for extensive debulking, thereby lowering the risk of both reherniation and post-operative complications
Solution Approach 2:
The suture acts as an intermediary element that bridges the annular defect, providing mechanical reinforcement to the weakened annulus. This intermediary structure allows the surgeon to maintain disc height and provide structural integrity without requiring extensive removal of nucleus pulposus material
2Ease of operation
If only the herniated portion is removed to treat radiculopathy, then the radiculopathy is treated, but the risk of post-operative reherniation increases
Solution Approach 1:
The annular defect is repaired with suture placement before completing the discectomy procedure. This preliminary repair establishes structural integrity at the defect site, allowing minimal debulking to be performed safely while maintaining low reherniation risk
Solution Approach 2:
The suture repair is applied locally at the annular defect site rather than requiring extensive debulking of the entire disc. This localized reinforcement provides targeted structural support that prevents reherniation while preserving healthy disc tissue and maintaining disc height
3Device complexity
If a unidirectional suture passing instrument is used, then the instrument structure is simpler, but the ability to approximate tissue edges effectively is reduced
Solution Approach 1:
The suture passing instrument is divided into two separate cannulations (first and second cannulations) that can independently pass sutures in opposite directions. This segmentation allows each cannulation to be optimized for its specific direction of suture passage, enabling effective tissue approximation from both sides of the defect
Solution Approach 2:
The instrument transitions from unidirectional to bidirectional suture passing by adding a second cannulation that operates in the opposite direction. This dimensional change from single-direction to dual-direction capability enables more effective tissue approximation by allowing sutures to be passed from both the proximal and distal sides of the defect
Data Source
AI summary
A bi-directional suture passing instrument is disclosed. The suture passing instrument may include a housing having a first cannulation and a second cannulation that is spaced from the first cannulation by a tissue receiving gap. The instrument may also include a shuttling element movable across the tissue receiving gap between the first and second cannulations. The shuttling element is configured to carry a strand of suture. A first pusher disposed in the first cannulation is configured to push the shuttling element from the first cannulation toward the second cannulation, and a second pusher disposed in the second cannulation is configured to push the shuttling element from the second cannulation toward the first cannulation.